Diagnosis and Management of Pyelonephritis

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OF the four common nephropathies, glomerulonephritis, nephrosclerosis, intercapillary glomerulosclerosis and pyelonephritis, at present only pyelonephritis, the most familiar of these, offers the possibility of arrest or cure. It has been strangely neglected, possibly because it is a nosologic stepchild, half surgical and half medical. Volhard and Fahr in 19141 did not list it among medical diseases of the kidney nor did Addis in 1925.2 Apart from the pediatric, obstetric and urologic aspects, little of general interest was written about it until 1939 when Weiss and Parker3 explored its relationship to hypericnsive disease. In 1948 Raaschau4 of Copenhagen published an excellent monograph on the subject with extensive pathologic and clinical studies. His most striking observation concerns its incidence. Among 3607 routine autopsies he found histopathologic evidence of pyelonephritis in 5.6 per cent. One half of these persons had died of renal failure but in only 1 out of 6 was the condition recognized ante mortem. Undoubtedly, if a disease is both common and remediable, its diagnosis and treatment are of general interest.

Etiology and Pathology

The most common organisms in pyelonephritis are colon bacilli and hemolytic streptococci. In some cases the infection is secondary to lesions which prevent free urinary drainage. In this group surgical correction of the causes of urinary stasis usually permits eradication of infection. Among the remaining patients the process is primary with no demonstrable anatomic abnormality. The organisms apparently reach the kidney substance through the blood stream. The pelvis and lower urinary tract become involved by contamination. . .



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